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Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study

BACKGROUND: Evidence for the efficacy of TIPSS in ectopic variceal bleeding (EctVB) is largely based on relatively small series. AIM: To define the efficacy of TIPSS in EctVB. METHODS: Retrospective analysis of consecutive patients with chronic liver disease who presented with EctVB and received TIP...

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Autores principales: Oey, Rosalie C., de Wit, Koos, Moelker, Adriaan, Atalik, Tugce, van Delden, Otto M., Maleux, Geert, Erler, Nicole S., Takkenberg, R. Bart, de Man, Robert A., Nevens, Frederik, van Buuren, Henk R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221146/
https://www.ncbi.nlm.nih.gov/pubmed/30136292
http://dx.doi.org/10.1111/apt.14947
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author Oey, Rosalie C.
de Wit, Koos
Moelker, Adriaan
Atalik, Tugce
van Delden, Otto M.
Maleux, Geert
Erler, Nicole S.
Takkenberg, R. Bart
de Man, Robert A.
Nevens, Frederik
van Buuren, Henk R.
author_facet Oey, Rosalie C.
de Wit, Koos
Moelker, Adriaan
Atalik, Tugce
van Delden, Otto M.
Maleux, Geert
Erler, Nicole S.
Takkenberg, R. Bart
de Man, Robert A.
Nevens, Frederik
van Buuren, Henk R.
author_sort Oey, Rosalie C.
collection PubMed
description BACKGROUND: Evidence for the efficacy of TIPSS in ectopic variceal bleeding (EctVB) is largely based on relatively small series. AIM: To define the efficacy of TIPSS in EctVB. METHODS: Retrospective analysis of consecutive patients with chronic liver disease who presented with EctVB and received TIPSS in three tertiary centres in 1992‐2016. RESULTS: The study included 53 patients (70% male, median age 61 years, median model for end‐stage liver disease (MELD) score 11). The ectopic varices were located around the insertion of stomas (40%), duodenum (23%), rectum (17%) and at other sites (20%). Three‐quarters of the patients had previously received unsuccessful medical, endoscopic or surgical therapy. The median follow‐up was 14.0 months. Following TIPSS, bleeding recurred in 12 patients: 6 of 12 (50%) with duodenal varices, 2 of 9 (22%) with rectal varices and one each with stomal (1/21), intraperitoneal (1/3), hepaticojejunostomy (1/2) and ascending colon varices (1/2). The risk factors for re‐bleeding were MELD score at TIPSS placement (HR: 1.081 per point; 95% confidence interval (CI): 1.012‐1.153; P = 0.034), varices located at site other than an enterostomy (HR: 9.770; 95%CI: 1.241‐76.917; P = 0.030) and previous local therapy (HR: 5.710; 95%CI: 1.211‐26.922; P = 0.028). The estimated cumulative re‐bleeding rate was 23% at 1 year, 26% at 3 years and 32% at 5 years. Post‐TIPSS hepatic encephalopathy manifested or worsened in 16 of 53 patients (30%). CONCLUSION: TIPSS provides long‐term control of bleeding in most cirrhotic patients with EctVB. TIPSS is particularly effective in stomal EctVB, the most frequent cause of EctVB, but might not be as effective in duodenal EctVB.
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spelling pubmed-62211462018-11-15 Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study Oey, Rosalie C. de Wit, Koos Moelker, Adriaan Atalik, Tugce van Delden, Otto M. Maleux, Geert Erler, Nicole S. Takkenberg, R. Bart de Man, Robert A. Nevens, Frederik van Buuren, Henk R. Aliment Pharmacol Ther Tipss for Ectopic Variceal Bleeding BACKGROUND: Evidence for the efficacy of TIPSS in ectopic variceal bleeding (EctVB) is largely based on relatively small series. AIM: To define the efficacy of TIPSS in EctVB. METHODS: Retrospective analysis of consecutive patients with chronic liver disease who presented with EctVB and received TIPSS in three tertiary centres in 1992‐2016. RESULTS: The study included 53 patients (70% male, median age 61 years, median model for end‐stage liver disease (MELD) score 11). The ectopic varices were located around the insertion of stomas (40%), duodenum (23%), rectum (17%) and at other sites (20%). Three‐quarters of the patients had previously received unsuccessful medical, endoscopic or surgical therapy. The median follow‐up was 14.0 months. Following TIPSS, bleeding recurred in 12 patients: 6 of 12 (50%) with duodenal varices, 2 of 9 (22%) with rectal varices and one each with stomal (1/21), intraperitoneal (1/3), hepaticojejunostomy (1/2) and ascending colon varices (1/2). The risk factors for re‐bleeding were MELD score at TIPSS placement (HR: 1.081 per point; 95% confidence interval (CI): 1.012‐1.153; P = 0.034), varices located at site other than an enterostomy (HR: 9.770; 95%CI: 1.241‐76.917; P = 0.030) and previous local therapy (HR: 5.710; 95%CI: 1.211‐26.922; P = 0.028). The estimated cumulative re‐bleeding rate was 23% at 1 year, 26% at 3 years and 32% at 5 years. Post‐TIPSS hepatic encephalopathy manifested or worsened in 16 of 53 patients (30%). CONCLUSION: TIPSS provides long‐term control of bleeding in most cirrhotic patients with EctVB. TIPSS is particularly effective in stomal EctVB, the most frequent cause of EctVB, but might not be as effective in duodenal EctVB. John Wiley and Sons Inc. 2018-08-22 2018-11 /pmc/articles/PMC6221146/ /pubmed/30136292 http://dx.doi.org/10.1111/apt.14947 Text en © 2018 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Tipss for Ectopic Variceal Bleeding
Oey, Rosalie C.
de Wit, Koos
Moelker, Adriaan
Atalik, Tugce
van Delden, Otto M.
Maleux, Geert
Erler, Nicole S.
Takkenberg, R. Bart
de Man, Robert A.
Nevens, Frederik
van Buuren, Henk R.
Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title_full Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title_fullStr Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title_full_unstemmed Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title_short Variable efficacy of TIPSS in the management of ectopic variceal bleeding: a multicentre retrospective study
title_sort variable efficacy of tipss in the management of ectopic variceal bleeding: a multicentre retrospective study
topic Tipss for Ectopic Variceal Bleeding
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221146/
https://www.ncbi.nlm.nih.gov/pubmed/30136292
http://dx.doi.org/10.1111/apt.14947
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